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136 Division St Waite Park MN 56387-1330 | |
| (651) 621-4112 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 136 Division St, Waite Park, Minnesota |
| Authorized Official Name and Position | Olatunde Olumuyiwa (OWNER) |
| Authorized Official Contact | 3202814449 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
136 Division St Waite Park MN 56387-1330 Ph: (320) 281-4449 | 136 Division St Waite Park MN 56387-1330 Ph: (651) 621-4112 |
| NPI Number | 1891271409 |
|---|---|
| Provider Enumeration Date | 07/17/2018 |
| Last Update Date | 04/16/2022 |
| Certification Date | 04/16/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891271409 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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Cos Pllc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 384 3rd St Ne, Waite Park, MN 56387 Phone: 320-250-9188 Fax: 320-396-7300 | |
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Jennifer L. Miller, Ph.d., Lp, Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 110 2nd St S Ste 303, Waite Park, MN 56387 Phone: 320-217-6025 Fax: 320-774-3005 | |